Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Eur Urol. 2011 Mar;59(3):317-22. doi: 10.1016/j.eururo.2010.10.045. Epub 2010 Nov 10.
Previous studies have shown that complications and biochemical recurrence rates after radical prostatectomy (RP) vary between different surgeons to a greater extent than might be expected by chance. Data on urinary and erectile outcomes, however, are lacking.
In this study, we examined whether between-surgeon variation, known as heterogeneity, exists for urinary and erectile outcomes after RP.
DESIGN, SETTING, AND PARTICIPANTS: Our study consisted of 1910 RP patients who were treated by 1 of 11 surgeons between January 1999 and July 2007.
All patients underwent RP at Memorial Sloan-Kettering Cancer Center.
Patients were evaluated for functional outcome 1 yr after surgery. Multivariable random effects models were used to evaluate the heterogeneity in erectile or urinary outcome between surgeons, after adjustment for case mix (age, prostate-specific antigen, pathologic stage and grade, comorbidities) and year of surgery.
We found significant heterogeneity in functional outcomes after RP (p<0.001 for both urinary and erectile function). Four surgeons had adjusted rates of full continence <75%, whereas three had rates >85%. For erectile function, two surgeons in our series had adjusted rates <20%; another two had rates >45%. We found some evidence suggesting that surgeons' erectile and urinary outcomes were correlated. Contrary to the hypothesis that surgeons "trade off" functional outcomes and cancer control, better rates of functional preservation were associated with lower biochemical recurrence rates.
A patient's likelihood of recovering erectile and urinary function may differ depending on which of two surgeons performs his RP. Functional preservation does not appear to come at the expense of cancer control; rather, both are related to surgical quality.
之前的研究表明，根治性前列腺切除术（RP）后的并发症和生化复发率在不同外科医生之间的差异比预期的随机差异要大得多。然而，关于尿和勃起功能的结果数据却缺乏。
在这项研究中，我们研究了 RP 后尿和勃起功能的结果是否存在外科医生之间的差异，即异质性。
设计、地点和参与者：我们的研究包括 1910 名 RP 患者，他们由 11 名外科医生中的 1 名在 1999 年 1 月至 2007 年 7 月期间进行治疗。
所有患者均在纪念斯隆-凯特琳癌症中心接受 RP 治疗。
患者在手术后 1 年接受功能结果评估。多变量随机效应模型用于评估外科医生之间在勃起或尿功能结果方面的异质性，调整了病例组合（年龄、前列腺特异性抗原、病理分期和分级、合并症）和手术年份。
我们发现 RP 后功能结果存在显著的异质性（尿和勃起功能均为 p<0.001）。四位外科医生的完全控尿率调整后<75%，而三位外科医生的控尿率调整后>85%。在我们的研究中，有两位外科医生的勃起功能调整后率<20%；另外两位外科医生的勃起功能调整后率>45%。我们发现一些证据表明外科医生的勃起和尿功能结果是相关的。与外科医生“权衡”功能结果和癌症控制的假设相反，功能保存率较高与生化复发率较低相关。
患者恢复尿和勃起功能的可能性可能取决于为其进行 RP 的两位外科医生中的哪一位。功能保存似乎不会以牺牲癌症控制为代价；相反，两者都与手术质量有关。
